Mycin

MYCIN was an early expert system that used artificial intelligence to identify bacteria causing severe infections, such as bacteremia and meningitis, and to recommend antibiotics, with the dosage adjusted for patient's body weight — the name derived from the antibiotics themselves, as many antibiotics have the suffix "-mycin". The Mycin system was also used for the diagnosis of blood clotting diseases.

MYCIN was never actually used in practice but research indicated that it proposed an acceptable therapy in about 69% of cases, which was better than the performance of infectious disease experts who were judged using the same criteria.

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MYCIN operated using a fairly simple inference engine, and a knowledge base of ~600 rules. It would query the physician running the program via a long series of simple yes/no or textual questions. At the end, it provided a list of possible culprit bacteria ranked from high to low based on the probability of each diagnosis, its confidence in each diagnosis' probability, the reasoning behind each diagnosis (that is, MYCIN would also list the questions and rules which led it to rank a diagnosis a particular way), and its recommended course of drug treatment.

Despite MYCIN's success, it sparked debate about the use of its ad hoc, but principled, uncertainty framework known as "certainty factors". The developers performed studies showing that MYCIN's performance was minimally affected by perturbations in the uncertainty metrics associated with individual rules, suggesting that the power in the system was related more to its knowledge representation and reasoning scheme than to the details of its numerical uncertainty model. Some observers felt that it should have been possible to use classical Bayesian statistics. MYCIN's developers argued that this would require either unrealistic assumptions of probabilistic independence, or require the experts to provide estimates for an unfeasibly large number of conditional probabilities.[1][2]

Subsequent studies later showed that the certainty factor model could indeed be interpreted in a probabilistic sense, and highlighted problems with the implied assumptions of such a model. However the modular structure of the system would prove very successful, leading to the development of graphical models such as Bayesian networks.[3]

Research conducted at the Stanford Medical School found MYCIN to propose an acceptable therapy in about 69% of cases, which was better than the performance of infectious disease experts who were judged using the same criteria. This study is often cited as showing the potential for disagreement about thereapeutic decisions, even among experts, when there is no "gold standard" for correct treatment.[4]

MYCIN was never actually used in practice. This wasn't because of any weakness in its performance. As mentioned, in tests it outperformed members of the Stanford medical school faculty. Some observers raised ethical and legal issues related to the use of computers in medicine — if a program gives the wrong diagnosis or recommends the wrong therapy, who should be held responsible? However, the greatest problem, and the reason that MYCIN was not used in routine practice, was the state of technologies for system integration, especially at the time it was developed. MYCIN was a stand-alone system that required a user to enter all relevant information about a patient by typing in responses to questions MYCIN posed. The program ran on a large time-shared system, available over the early Internet (ARPANet), before personal computers were developed. In the modern era, such a system would be integrated with medical record systems, would extract answers to questions from patient databases, and would be much less dependent on physician entry of information. In the 1970s, a session with MYCIN could easily consume 30 minutes or more—an unrealistic time commitment for a busy clinician.

MYCIN's greatest influence was accordingly its demonstration of the power of its representation and reasoning approach. Rule-based systems in many non-medical domains were developed in the years that followed MYCIN's introduction of the approach. In the 1980s, expert system "shells" were introduced (including one based on MYCIN, known as E-MYCIN (followed by KEE)) and supported the development of expert systems in a wide variety of application areas.

A difficulty that rose to prominence during the development of MYCIN and subsequent complex expert systems has been the extraction of the necessary knowledge for the inference engine to use from the human expert in the relevant fields into the rule base (the so-called "knowledge acquisition bottleneck").